A Review of Clinical Practice Guidelines and Treatment Recommendations for Cancer Care in the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has inevitably caused those involved in cancer care to change clinical practice in order to minimize the risk of infection while maintaining cancer treatment as a priority. General advice during the pandemic suggests that most patients continue with ongoing therapies or planned surgeries, while follow-up visits may instead be delayed until the resolution of the outbreak. We conducted a literature search using PubMed to identify articles published in English language that reported on care recommendations for cancer patients during the COVID-19 pandemic from its inception up to 1st June 2020, using the terms “(cancer or tumor) AND (COVID 19)”. Articles were selected for relevance and split into five categories: (1) personal recommendations of single or multiple authors, (2) recommendations of single authoritative centers, (3) recommendations of panels of experts or of multiple regional comprehensive centers, (4) recommendations of multicenter cooperative groups, (5) official guidelines or recommendations of health authorities. Of the 97 included studies, 10 were personal recommendations of single or multiple independent authors, 16 were practice recommendations of single authoritative cancer centers, 35 were recommendations provided by panel of experts or of multiple regional comprehensive centers, 19 were cooperative group position papers, and finally, 17 were official guidelines statements. The COVID-19 pandemic is a global emergency, and has rapidly modified our clinical practice. Delaying unnecessary treatment, minimizing toxicity, and identifying care priorities for surgery, radiotherapy, and systemic therapies must be viewed as basic priorities in the COVID-19 era.

Changes in management of patients with cancer during COVID-19 pandemic

“…perforated, bleeding cancers) [22]. In breast cancer, radiotherapy should be delayed or omitted, as suggested by experts from the Memorial Sloan Kettering Cancer Center in New York [25]. They suggest abandoning the radiation treatment in the case of ductal carcinoma in situ, among women aged 70 or more, invasive estrogen-receptor positive cancer, tumour smaller than 3 cm, without nodal metastasis and with negative resection margins.…”

“…They suggest abandoning the radiation treatment in the case of ductal carcinoma in situ, among women aged 70 or more, invasive estrogen-receptor positive cancer, tumour smaller than 3 cm, without nodal metastasis and with negative resection margins. On the other hand, the diagnosis of inflammatory breast or triple negative node-positive disease and the presence of node-positive (N2) disease are high priority indications for breast radiotherapy [25].…”

“…As chemotherapy results in the decrease in the amount of lymphocytes, it contributes to the infection of SARS-CoV-2 [32]. It has been also advised to switch from intravenous to oral correspondent formulations such as etoposide and vinorelbine [25].…”

“…According to the National Health System in England, hospitals should only admit patients who will require surgery within the next 24-72hours[23]. In order to minimize the risk of infection, low-risk cancers should be treated with minimally invasive surgical procedures, while open surgeries should be replaced with transoral procedures[25]. Particular precautions should be taken among patients with tracheostomy or total laryngectomy, who are at the high risk of virus aerosolization[25].Yu et al suggested that colorectal cancer (CRC) patients should undergo laparoscopyassisted radical surgery[26].…”

“…In order to minimize the risk of infection, low-risk cancers should be treated with minimally invasive surgical procedures, while open surgeries should be replaced with transoral procedures[25]. Particular precautions should be taken among patients with tracheostomy or total laryngectomy, who are at the high risk of virus aerosolization[25].Yu et al suggested that colorectal cancer (CRC) patients should undergo laparoscopyassisted radical surgery[26]. They advise Natural Orifice Specimen Extraction (NOSE) andTransanal Total Mesorectal Excision (taTME) to be performed with caution, as well as they recommend to strengthen protection of operating room personnel[26].…”